Minimally Invasive Techniques for Repair of Tetralogy of Fallot

The complexity of cardiac surgery precludes its application via minimally invasive approaches compared to other surgical specialties. Despite these complexities, minimally invasive cardiac surgery (MICS) has been applied in procedures such as coronary artery bypass grafting (CABG), valve repairs and replacement (1), and, more recently, for congenital heart defects (CHD) (2). 
 
This case provides insight into the application of minimally invasive cardiac surgery (MICS) in patients with tetralogy of Fallot requiring multiple intracardiac repairs. The authors found no difficulty in conducting the surgery, achieving early weaning from the ventilator and a shorter intensive care unit (ICU) and overall hospital stay compared to routine sternotomy, along with an excellent cosmetic outcome. The authors concluded that MICS was a safe and feasible option compared to routine sternotomy. 

Patient Presentation 

A 31-year-old female presented with complaints of cyanosis and breathlessness on exertion. Echocardiography revealed a large malaligned subaortic ventricular septal defect, severe valvular and infundibular pulmonary stenosis, no additional atrial septal defect, ventricular septal defect, confluent good-sized pulmonary arteries, and normal biventricular function. The patient was diagnosed with tetralogy of Fallot and underwent intracardiac repair using a minimally invasive technique. 

References

1. Langer NB, Argenziano M. Minimally Invasive Cardiovascular Surgery: Incisions and Approaches. Methodist Debakey Cardiovasc J. 2016 Jan-Mar;12(1):4-9. doi: 10.14797/mdcj-12-1-4. PMID: 27127555; PMCID: PMC4847968.
2. Gupta S, McEwen C, Eqbal A, Haller C. Minimally invasive surgery for congenital heart disease. The Annals of Thoracic Surgery. 2024 Oct 1;118(4):953-62.

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